General QOL - Quality of Life - Assesment

Answer based on your Sexual and Urinary Function activity over the last 4 weeks ....

Name *
Name
Q1 - Are you having Erections? *
SHIM SCORE
SHIM Score with Medication
Q7 - Do you have a Penile Implant?
Q10 - Do you use a VACUUM Device?
IPSS or AUA Symptom Score
Taking Dutasteride, Finasteride, Duodart
On Testosterone replacement therapy
On Androgen Deprivation Therapy (Lupron, Zoladex, ETC)